GLP-1 Drugs in Fertility Care: Review and Pilot Patient Survey

The blockbuster weight-loss drugs known as GLP-1 receptor agonists have become one of the most talked-about medical phenomena of the decade, but a new study from the University of Florida suggests that when it comes to fertility care, women are largely navigating this revolution on their own. The research, published in Reproductive Sciences, combines a sweeping narrative review of the scientific literature with an investigational pilot survey of patients at an academic infertility clinic, and it reveals a striking communication gap: while the vast majority of women seeking fertility treatment know about GLP-1 medications, very few have actually discussed them with the physicians guiding their reproductive care.

The numbers are arresting. Among patients surveyed, 86 percent were aware of GLP-1 receptor agonists, the class of drugs that includes semaglutide and liraglutide, yet only 19.3 percent had had substantive discussions about them with a healthcare provider. That disconnect is all the more remarkable given that 84.2 percent of the respondents had actively attempted to lose weight within the previous year. In other words, patients are trying to address the very problem that GLP-1 medications are designed to solve, they know the drugs exist, but the conversation with their fertility specialists simply is not happening.

Why does this matter for reproductive medicine? The answer lies in the biology of obesity and fertility. Excess body weight disrupts the hypothalamic-pituitary-ovarian axis, the hormonal cascade that governs ovulation and menstrual cyclicity. In women with polycystic ovary syndrome, or PCOS, obesity frequently compounds underlying insulin resistance and hyperandrogenism, driving irregular cycles and anovulation. Weight loss of even five to ten percent of body mass can restore ovulation and improve the odds of conception, which is why lifestyle modification remains the first-line recommendation for overweight and obese patients entering fertility treatment. But achieving clinically meaningful and sustained weight loss through diet and exercise alone is notoriously difficult, and that is where pharmacotherapy enters the picture.

GLP-1 receptor agonists were originally developed to treat type 2 diabetes. They mimic glucagon-like peptide-1, an incretin hormone released by the gut after meals that stimulates insulin secretion in a glucose-dependent manner, suppresses glucagon, slows gastric emptying, and acts on appetite centers in the central nervous system. The combined metabolic and neurologic effects produce substantial weight reduction. Semaglutide, approved for chronic weight management as Wegovy, demonstrated mean weight losses approaching fifteen percent in pivotal trials. More recently, tirzepatide, a dual GIP and GLP-1 receptor co-agonist marketed as Mounjaro and Zepbound, has pushed results even further. These agents work by binding the GLP-1 receptor, a G protein-coupled receptor expressed not only in pancreatic beta cells and the brain but also, intriguingly, in reproductive tissues.

That tissue distribution is the crux of the review’s scientific argument. Animal and human studies suggest that GLP-1 signaling may have direct effects on the ovary, the endometrium, and the hypothalamic neurons that regulate gonadotropin release. In mouse models of PCOS induced by dehydroepiandrosterone, GLP-1 receptor agonists reduced hyperinsulinemia and hyperandrogenemia, mitigated inflammation, and promoted browning of white adipose tissue. In women, randomized trials of liraglutide have shown improvements in ovarian dysfunction markers, reductions in ectopic fat deposits, and, in one pilot study, increased IVF pregnancy rates among obese PCOS patients who responded poorly to first-line reproductive treatments. A meta-analysis covering multiple GLP-1 receptor agonist trials reported gains in pregnancy rate and menstrual cyclicity among women with PCOS, and combination therapy with exenatide and metformin has outperformed metformin alone in restoring cycles and achieving pregnancy.

The story is not limited to women. Obesity-associated functional hypogonadism in men, characterized by low testosterone and impaired sperm parameters, has also shown response to liraglutide treatment, with preliminary data indicating improvements in sexual and reproductive outcomes in obese fertile men. Systematic reviews examining GLP-1 receptor agonist effects on testicular dysfunction have followed, and authors caution that the potential impact on male fertility remains underexplored, a “fable of caution” in the words of one research group, since the drugs are now prescribed to millions of men of reproductive age.

Perhaps the most pressing clinical question is pregnancy safety. Because these agents slow gastric emptying, there has been theoretical concern that they could reduce the absorption of oral contraceptives, an issue addressed in regulatory prescribing information and examined in a 2025 statement from the Faculty of Sexual and Reproductive Healthcare. Notably, a pharmacokinetic study found that once-weekly semaglutide did not reduce the bioavailability of a combined ethinylestradiol and levonorgestrel oral contraceptive. On teratogenicity, the emerging evidence is cautiously reassuring. A multicenter prospective cohort study drawing on six Teratology Information Services databases found no signal of major congenital malformation risk from GLP-1 receptor agonist exposure in early pregnancy, and a large nationwide Danish cohort study similarly reported no increase in pregnancy complications associated with early-pregnancy exposure. Case reports of liraglutide and dulaglutide exposure during the first weeks of pregnancy have described normal outcomes, and animal research even suggests that the GLP-1 mimetic exendin-4 may improve inflammation-induced adverse pregnancy and neonatal outcomes. Nevertheless, because long-term human data remain limited, current prescribing labels generally recommend discontinuation before attempting conception, and guidelines from the American College of Obstetricians and Gynecologists on obesity in pregnancy continue to emphasize weight optimization prior to conception.

It is against this evolving backdrop that the University of Florida team, led by Alexander L. Vlasak of the Mayo Clinic’s Department of Orthopedic Surgery in collaboration with researchers at the University of Colorado Anschutz and the University of Florida’s Division of Reproductive Endocrinology and Infertility, designed their pilot survey. The anonymous, institutional review board-approved instrument was distributed to women seeking care at a single academic infertility clinic, with data captured and de-identified through the REDCap electronic data capture platform. The survey probed patients’ perceptions of their weight, the weight-loss methods they had tried, and their awareness of GLP-1 medications. The investigators paired this primary data with a narrative review of the reproductive medicine literature on GLP-1 receptor agonists, ultimately producing clinic recommendations aimed at closing the patient-provider communication gap.

The central recommendation is straightforward: fertility specialists should initiate conversations about weight-loss pharmacotherapy rather than waiting for patients to raise the topic. Given that roughly one in five surveyed patients had a substantive provider discussion despite near-universal awareness, the onus falls on clinicians to bring evidence-based medical weight management into the infertility consultation. The authors argue that for patients with obesity-related infertility, GLP-1 receptor agonists may offer a unique therapeutic advantage through a three-pronged mechanism: clinically significant weight loss, broader metabolic improvement including enhanced insulin sensitivity, and possible direct reproductive effects mediated by GLP-1 receptors in the hypothalamus, ovary, and endometrium.

Yet the review is careful not to overpromise. The evidence base, while growing, consists largely of small randomized trials, pilot studies, and observational data, frequently concentrated in PCOS populations. Large, adequately powered randomized controlled trials with reproductive outcomes as primary endpoints are still lacking, and questions about the optimal duration of treatment before conception, the appropriate washout interval, and long-term offspring outcomes remain open. Cost and insurance coverage pose additional practical barriers, as these agents remain expensive and formulary restrictions are common. The authors also received no external funding for the work and report no conflicts of interest, underscoring that the call for expanded patient counseling reflects scientific judgment rather than commercial interest.

What emerges from the study is a portrait of a field in transition. Obesity now affects hundreds of millions of adults worldwide according to the World Health Organization, and its contribution to infertility is substantial and rising. GLP-1 receptor agonists have already transformed the treatment of diabetes and obesity; their migration into reproductive medicine appears increasingly plausible, supported by mechanistic biology and a growing roster of encouraging clinical signals. The Florida survey adds a human dimension to that migration, reminding the field that patients are not passive recipients of these trends. They arrive at fertility clinics already informed, already motivated, and already trying to lose weight, often without professional guidance on how the newest pharmacological tools might fit into their reproductive plans. Bridging that gap, the authors conclude, may be one of the simplest and most consequential steps reproductive endocrinologists can take to improve outcomes for their patients.